Join our very own culture change pundit Carmen Bowman, MHS, on her monthly web talk show. Actually, it's even better than a talk show because you too can join the conversation by asking questions of Carmen and her guests. Carmen's smart look at culture change focuses on a wide variety of topics. She brings an insider's view of regulations, and reports on little changes happening in government, in attitude, in practice. Each month she will share culture change news and updates, amusing and heartwarming stories, and interview a guest on a relevant and timely topic. Check back regularly as we announce new topics.

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JANUARY 18, 2019

TOPIC: Weaving the Eden Alternative Domains of Well-BeingSM into LIFE

GUEST: Schlegel Villages of Canada Team

Schlegel Villages takes their culture change journey, initiated in 2010, very seriously. With three years of transformation work behind them, they began incorporating Eden Alternative's seven Domains of Well-Being into their organization in 2014. In this show, the Schlegel Villages team will share

• How they introduced the domains to the larger team
• How they use the domains
• Their ME form, and
• How they use the Wellbeing tool developed by Dr. Al Power, Eden Educator and Board Member.

Did you know the seven Domains of Well-Being made it into the new CMS regulations? Join us to learn more.

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FEBRUARY 15, 2019

TOPIC: Fake Life and Real Life - Let's Talk!

GUEST: Sonya Barsness, Gerontologist

How much of what is offered to people living in long term care communities is fake?

Much is at stake with fake. Let's call it out and consider why we think it’s okay. We’ll talk about examples, like using fake pets and babies, mock tails and near beer, the folding of fake towels and whether we are asking the right questions in thinking about if and when to use them. Let's compare it to real and what each says about how we care for and treat older adults. We’ll be honest, our bias is to encourage all to move more in the direction of real life rather than fake. Let’s compare what our goals are when we are fake and contrast it with what we want for people - real living.

STAY TUNED FOR THE 2019 LINEUP

PREVIOUS SHOWS

Most of the shows listed below can be viewed at your workplace for the same $99 cost.

2018

Empira has been working to better understand the wants and needs of older adults, given the following:

1. The primary reason for many behavioral expressions centers around the lack of support for “work of aging”

2. The ultimate success of inevitable aging is the ability to maintain integrity with a sense of closure and completeness and accept death without fear.

Based on these understandings, an approach called ResoLute (Resident Empowered Solutions on Living Until The End) is currently in development to support conversations about life and mortality - to identify and uphold what matters most.

OCTOBER 12, 2018

TOPIC: KNOW BETTER, DO BETTER, Part Three

GUEST: Sarah Brown, E.D. Empira

The status quo had to change.

Consider these facts:

- Restorative sleep is vital to the overall wellbeing of humans

- Sleep fragmentation is a primary contributor to some of the most challenging issues facing long term care (e.g. falls, behavioral expression, pain, incontinence, skin breakdown, unnecessary use of antipsychotics, function decline and the list goes on)

Empira recognized the challenge and is now making a "night and day" difference for the residents they serve through a culture of restorative sleep. For this, the 3rd show in our series, Sarah Brown will share what Empira has learned, how they transformed their culture and the impact of this on residents.

The second show in the series will share Empira's findings regarding what really causes falls, i.e. noise -- and meaningful ways to reduce falls other than alarms.

Empira is a consortium of Aging Service providers who are committed to improving the aging experience by knowing and doing better. Collectively, the organizations that make up Empira challenge the status quo by understanding the root cause of problems and outcomes. By understanding the root cause, they are able to create meaningful and sustainable culture change. They have created a signature series on
1. Falls
2. Restorative sleep
3. Behavioral expression and
4. Work of aging

Hear about their approach to quality improvement that focuses on human needs and behavior.

AUGUST 10, 2018

TOPIC: KNOW BETTER, DO BETTER Part 1

GUEST: Sarah Brown, E.D. Empira

Empira is a consortium of Aging Service providers who are committed to improving the aging experience by knowing and doing better. Collectively, the organizations that make up Empira challenge the status quo by understanding the root cause of problems and outcomes. By understanding the root cause, they are able to create meaningful and sustainable culture change. They have created a signature series on

1. Falls

2. Restorative sleep

3. Behavioral expression and

4. Work of aging

Hear about their approach to quality improvement that focuses on human needs and behavior.

JULY 13, 2018

TOPIC: Become a Community Developer: Champion of an Elder-Centered Culture

GUEST: Barry Barkan, Director Live Oak Institute

Learn from Pioneer Barry Barkan how to be a community developer who is a champion for:

elders

culture

the highest possible good

one’s own learning and growth

the organization of which he/she is a part.

Be challenged as a community developer to assist elders to be active participants in their home as well as the wider society, to live in the present, draw from the past, and prepare for the future. Learn to be a community developer who stands up for the individual who has no one else and attempts to have an even hand, loving each person – even those whose behavior and beliefs we might disagree with or find difficult.

JUNE 8, 2018

TOPIC: The Value of Hosting a Kids Day Camp

GUEST: Beth Irtz, Administrator Shalom Park

Learn how a day camp can easily be made part of life in your community, from lessons learned in three day camps during the summer of 2017. Outcomes for both youth and residents were so powerful that you may wonder why every nursing home doesn’t host a summer day camp!

Guest Beth Irtz and Hostess Carmen Bowman received a CO CMP grant to offer the camps. Together they will share how you can make such a meaningful week happen in your community.

MAY 11, 2018

TOPIC: BLACK BALLOONS OR A RAINBOW OF COLORS: How Our Perceptions of Aging Affect the Care We Provide

We’ve all done it—sent an “over the hill” card to someone, purchased “anti-aging” products, refused to say our age and maybe even given the dreadful black balloons on a milestone birth celebration. It’s part of our culture, right? It’s meant to be funny. It helps us cope with the fact we’re getting older. But how does it really affect us? More importantly, how does it affect the care and support we provide to Elders? In this conversation we’ll explore how our own perceptions of getting older as well as those of the general society affect our long-term care system as well as our specific care practices. Let’s be the change we want to see!

We have been exploring resident health and well-being holistically, and in March we were inspired by The Transformative Power of Purpose, when we learned about and heard from residents of Rockport Healthcare Services' 70 communities in California who serve the homeless in their respective communities every month. In keeping with our theme, the show in April will look at the connection between engagement and cognitive health. Megan will share the most current research in cognitive science, brain health and engagement. We’ll discuss types of engagement and suggestions for ensuring meaningful engagement, as well as outcomes of engagement on well-being, quality of life and staff satisfaction.

MARCH 9, 2018

TOPIC: The Transformative Power of Purpose: Residents Serving their Communities

Residents of 80 nursing and assisted living homes regularly prepare meals and serve the homeless in their communities. We are impressed. Matthew Lysobey, developer of A Heart to Serve; Peggy Fraricks, resident founder and participant for 15 years, and Bonnie Jacobs, operational leader, will explain how Rockport Healthcare Services offers residents of their 80 homes the opportunity to volunteer on teams that give back to their communities. Regardless of their physical and cognitive challenges, all willing participants have a role in preparing and serving at the local homeless shelter, resulting in a renewed sense of purpose within themselves. Purpose reduces depression and symptoms of chronic conditions, and a National Institutes of Health study reveals that “having greater purpose in one’s life reduced the symptoms and progress of Alzheimer’s disease and other forms of dementia.” Wow -- with those results why wouldn’t every nursing home and assisted living community do this? Moreover, it takes a home even beyond compliance with CMS’ new focus on interaction in the community in the requirements and Critical Element Pathway for Activities.

SPECIAL OFFER: PURCHASE ACCESS TO THE RECORDING OF THIS SHOW AT 50% OFF

TOPIC: Even When Care and Compliance are Nearly Perfect, What Kind of Life are Residents Living?

And - The Artifacts of Living Well

PRESENTED BY: Sonya Barsness, Gerontologist, Consultant, Blogger

Imagine a nursing home that has “good care.” It has good outcomes. Maybe even the care truly reflects the individualized needs and preferences of people who are living there. But beyond the day to day services that are provided, how are people living? Are their days revolved around care? Or does their care support them to live well? Let’s talk about more than care, and more than care plans. Join us to be pushed to the next level as we discuss LIVING plans and the idea of Artifacts of Living Well.

Since 2007, Sunny Hill Nursing Home of Will County's residents have served on an employee hiring committee, hiring their own care givers. Managers review applications and conduct initial interviews but then applicants must meet with the resident committee which votes to accept or reject each applicant. Of almost 400 potential employees interviewed, the committee said no to approximately 50 and their opinion was honored. Learn how you too could honor resident choice to this degree. Administrator Becky Haldorson and resident Jamie Wesley, who serves on the committee, will share lessons learned, how to do this successfully and, in the end, inspire your community to live up to “this is your home now” - going beyond new CMS requirements for increased resident choice

2017

NOVEMBER 17, 2017
TOPIC: PHASE 2 CMS REQUIREMENTS: Are You Ready?

PRESENTED BY Carmen Bowman, Host

Phase 2 of the new CMS requirements are to be in place by Nov. 28, 2017. In this quick, one hour review, we will look at most Phase 2 requirements in detail. Let this be a moment for your team to gain a solid understanding of what is required and together assess your community’s compliance. Culture change wins, and practices that contribute to compliance will be highlighted.

Want to provide a great dining experience, preferences and choice and be in compliance with new CMS requirements? Learn how to work within budget & time restrictions, tackle cold food, high food waste, endless food preference list issues and how to move away from tray and pre-plate service to self-determined meal delivery that honors resident choice while saving money. Photos, real examples and many ideas will be shared to help communities implement practical culture change ideas with the confidence of the literature, best practices and federal requirements to back them up.

SEPTEMBER 15, 2017

TOPIC: WHAT LIVING LIKE A RESIDENT CAN TEACH LTC STAFF – The Power of Empathy to Transform Care

GUEST: LESLIE PEDTKE, LNHA,

Educator for Quality Improvement, King Management Company

What happens when real caregivers become “real” residents? How will their experiences change how they think about being a resident? How will the care they provide to residents change in the future?

Through the Looking Glass is an experience developed at Aviston Countryside Manor in IL. Staff members move into the nursing home, live the role of real diagnoses and accept daily “challenges” residents experience every day.

From learning the importance of communicating more with residents to encouraging meaning and purpose, the resulting insights of these caregivers sensitized other staff members – new and veteran – to practical and effective ways to immediately improve daily care and life for residents.

Hear the incredible outcomes such as the now required Elder Shadowing - all newly-hired staff live with a resident for 24 hours before they are able to begin their new job - the Resident Hiring Committee and Pedkte's new book with the same title.

Signature HealthCare is an organization that has committed to a changed culture in many ways. Join us for an immersive look at Signature HealthCare’s recently published research - and even more recent unpublished research - revealing positive outcomes in all aspects: satisfaction of residents, families and staff, decreased turnover, financial and clinical.

When looking at the CMS definition of a restraint, it can be viewed that locked doors also fit the definition. And yet they are almost a given in "memory care" environments. Is that something we must accept, or is it possible for people living with dementia to live in unlocked environments? This webinar will discuss the steps that organizations can begin to take to support everyone's human right to be able to walk and move about their home freely.

Now is the time to be a VOICE for CHOICE in your community’s food and nutrition services. Those of you who have lobbied for change to a more person-centered focus now have something tangible to back you up. Person-directed dining is no longer a nice idea. It’s a mandate. The new CMS requirements can be the megaphone that you will use to make person-directed dining a reality in your community. We will explore these CMS changes in food and nutrition services and explain their intent. We will also discuss the top three dining citations and what you can do to avoid them.

APRIL 14, 2017

TOPIC: FROM ANNOYANCES TO CONFLICT: What might miscommunication be costing your organization?

Day-to-day petty annoyances are experienced by each of us and are a fact of life. Without a strategic focus on recognizing and dealing with natural annoyances early, many grow into costly conflict events negatively impacting residents’ quality of care and quality of life. We will discuss how ordinary annoyances interrupt the smooth operation of any organization, how to best prepare team members for coping with annoyances and ways to wisely handle any resulting conflicts. Find out what conflict may be costing your organization.

Pre-webinar prep work includes access to the Mediation Training Institute Cost of Conflict Tool which Ray will refer to. Link will be sent to you in confirmation email. You should enter in basic information regarding an actual conflict situation you are handling.

MARCH 3, 2017

TOPIC: THE PERSONFIRST® PROCESS: PART 3 IN OUR SERIES ON DEMENTIA CARE & CMS

GUEST SPEAKER: MEGAN HANNAN, Action Pact Consultant

PersonFirst® is a proven train-the-trainer process for creating and sustaining a culture of person-directed life. Although its goal is to include anyone, it focuses especially on how to engage those living with dementia. In a PersonFirst® culture, people who live with dementia are valued as unique individuals who still have a need for purpose; to bring meaning to their lives and those around them. As we learn to recognize and nurture the identity of the person hidden behind the fog of dementia, a new vitality takes hold within the organization as those with cognitive loss come out of the shadows and join the care home’s circle of community and sharing. PersonFirst®, a nationally-recognized benchmark for person-centered culture, meets the CMS required guideline for a program to support person-centered service for those living with dementia. Join us and learn how PersonFirst® can take your dementia care culture to the next level.

This CMS survey ascertains a community’s compliance with Care and Services for a Resident with Dementia, Unnecessary Drugs, Assessment and Care Planning. Become familiar with the survey, surveyor worksheets and how both have been integrated into the survey process. Most importantly, ensure you know best practices both recognized by CMS and the culture change movement. Learn to view “behaviors” as communication; recognize dementia-related communications; be individual-centered, not institution-centered as CMS requires; offer meaningful engagement by all staff all day to reduce antipsychotics. It’s time to create a proactive, preventive, individualized, resident-focused dementia care culture.

NOVEMBER 18, 2016

TOPIC: Vibrant Living for Men, Compliance for Communities

GUEST: Glenn Blacklock, LNHA, Action Pact Consultant

Known nationally for his work bringing normal life pursuits to nursing home residents, Glenn will guide us in exploring options to help men live more vibrant and satisfying lives. As we know, men tend to get “lost in the shuffle” in the myriad of activity offerings that often seem to be geared toward women. We will discuss how meaningful engagement can’t just be left to activity/recreational professionals anymore. When all individuals in a community share their passions and interests, relationships flourish and spontaneity happens. As we all rethink what we can make happen for men, they often find new purpose and meaning in their lives, and their once-vibrant spirits will rise again. And although we are focusing well-deserved attention on men's needs here, the principles discussed apply to everyone.

* The discussion will include the new CMS regulation for Activities which goes into effect Nov. 28, 2016.

OCTOBER 21, 2016:

TOPIC: THE ALL-NEW CMS REGULATIONS - A First Look

PRESENTED BY: Carmen Bowman

With GUEST HOST: Glenn Blacklock, Action Pact Consultant

Last summer this same duo discussed the 403-page document of CMS’ proposed changes. A year later, trusting that CMS will follow through with the promised September release of the new regulations, they are seizing this opportunity to review the all-new CMS Regulations.

We all know that wheels were put on chairs for transportation. That certainly makes sense and provides people with any limitation on their ability to get from point A to point B. How is it then that individuals who reside in many communities dedicated to caring, spend the vast majority of their time awake sitting in a wheeled chair? Something has gone awry with the application of a very specialized piece of equipment. Wheeled chairs were never meant as seating devices. But then we all know that. We can also state all of the negative effects of having people sitting in a wheeled chair… but there are still way too many people doing just that. There’s a mismatch between what we know and what we practice. We will look at the underlying change in belief that must occur to move to a new culture where wheeled chairs become simply a mode of transportation, and are unoccupied most of the time.

With a flair for design for aging, environmental gerontologist Lorianne Hiatt will get us focused on what mobility is and why it matters to older adults. She will share best practice in assessment of individual mobility as well as of one’s life space with inclusion of direct care givers/partners and the resident him/herself. Be challenged to be creative in using whatever exists in your environment as well as new ideas to encourage movement every day. Learn considerations for persons living with dementia, ways to mitigate risk, and take a look at the MDS data points for personal movement, life-space mobility and reimbursement potential.

It is not news that the language of institutional care could use some work. Even CMS notes a needed language change by encouraging the elimination of labels such as “feeder” in its interpretive guidance for Tag F241 Dignity. Do these institutional words still abide in your culture? Facility, beds, frontline, work the floor, toileting, non-compliant, behaviors, difficult, activities, dietary, resident, elope, expire? Have you personally and community-wide adopted language that is softer, more normal, dignified? The best news? Changing language costs no money. Yes, changing language is a no-cost practice that does wonders to shift from an institutional culture to a home/natural/normal culture instead. Join us to learn more about the unintended consequences of traditional institutional language; word replacements to consider; and ideas on how to change language. Join our host Carmen Bowman as she shares from the paper she co-authored The Power of Language to Create Culture..

Approximately two-thirds of nursing home residents are in wheelchairs the majority of the time. Although not talked about much, the negative, iatrogenic consequences of overuse of wheelchairs are many: accelerated loss of muscle mass, pressure sores, significant discomfort and physical strain from operating chairs which increase risks for falling, injuries from falls, depression and pneumonia. Older people's health, mobility and self-image can suffer from too much time in wheelchairs. They are treated as less able, even spoken to differently, promoting a cycle of helplessness. The Forest at Duke is part of a movement that gives priority to the well-being of residents and their caregivers - above the functions of the nursing home or convenience of the staff. Join us and our guest Leslie Jerema to learn how she led her community to use wheel chairs for transport only and helps residents be as active as possible.

For years we have talked about preventing and reducing falls, searching for the right solution. We even tied people to their chairs to keep them from falling, not yet realizing that the key to preventing falls is to improve mobility. Then we “alarmed” them, which only resulted in increased immobility. Mobility is the key to maintaining both physical health and quality of life. The Advancing Excellence Campaign has selected Mobility as one of its nine goals. With an expert panel, it has prepared a full set of quality improvement tools to help assess, measure and improve mobility for nursing home residents. In this conversation, we’ll focus on:
· What mobility is
· Why maintaining/improving mobility is important
· How to measure mobility using an evidence-based tool
· How to incorporate mobility in your QAPI efforts
· How to use a root cause analysis to help you identify areas for improvement

April 22, 2016

TOPIC: Dignity-Based Approach to Incontinence

GUEST: Susan Fry, Retired Culture Change Nurse Leader

Guest Susan Fry will report out on a multisite research study regarding a dignity-based approach to incontinence management. Join us to hear both the change steps and the exciting improved outcomes realized:
• Disturbing residents less often increases comfort and dignity and respects natural sleep patterns, which improves alertness, appetite and nutrition while reducing confusion.
• Reducing the risk for falls by supporting residents to sleep naturally through the night without the need to get up to use the bathroom.
• Higher quality products keep skin dryer and promote skin health.
• Better leakage protection encourages resident confidence and security.
• Individualized care respects residents’ dignity and voiding patterns, and improves the level of participation in daily activities.

Presented by Carmen Bowman, co-author of "Alarms: The New Deficient Practice? Eliminating Alarms and Preventing Falls by Engaging with …. Life"

Join the discussion to ponder the use of alarms. Could it be that alarms actually fit CMS’ definition of “convenience,” which is not to be a reason for restraints at Tag F221? Hear how the use of alarms could be deficient practice on/for at least seven tags. Although no research shows that alarms prevent falls and there is evidence that alarms cause people physical and psychological harm, they are still used widely. Eliminating alarms has actually reduced falls in the homes that have done so, committing to the better practices of

proactively checking in with residents

focusing on mobility

anticipating needs and

engaging residents with real life

Based on the book Eliminating Alarms and Preventing Falls by Engaging with … Life co-authored by hostess Carmen Bowman, published by Action Pact.

Are you holding back on offering true choice to residents, even though you want to - for fear of deficiencies being cited, possible legal action or other negative outcomes? We challenge you to think again. It is possible to hone our skills in order to honor resident choice.

Everyone deserves the right to:
- Eat food that might be considered a choking risk,
- Go outside when one wants to
- Decline "alarming" alarms, etc.

Karen Schoeneman, a member of the steering committee of the Rothschild Person-Centered Care Planning Task Force, will teach the six steps of the new "Care Planning for Resident Choice" process, as well as the CMS requirements that mandate homes to honor resident choice.

FEBRUARY 5, 2016

TOPIC: The ROI of Using the Regulations to Promote Highest Practicable Quality of Life

GUEST: Ray Rusin, Retired Director, Rhode Island Survey Agency

Meeting basic needs should be a given. When they are, one can reach their highest practicable level of well-being. Yet health systems -- including the survey process -- tend to stratify efforts on the bottom tiers, focusing mostly on safety. Culture change outcomes are in our favor: improved quality of life and clinical outcomes, higher profit and better regulatory compliance. Learn how to use the existing and proposed regulations to promote highest practicable quality of life. Achieve the best ROI by having a thorough understanding of the CMS regulations.

See more archived shows in our webstore.

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Carmen's sessions are held the third Friday of every month at 12 noon Mountain time (11 am Pacific, 1 pm Central and 2 pm Eastern) and run about an hour each. To sign up, just click on the "To Register" button and pay online with your credit card through Paypal. Be sure to provide a valid email address so you can receive instructions on how to join the webinar. You can also register by calling our offices at (414) 258-3649.

Cancellations must be requested at least two weeks prior to the workshop. No refunds will be issued after that point. All refunds are subject to a 15% processing fee.

If you wish to transfer your registration to another session, you may do so at no charge, but please let us know as early as possible so we can fill your seat. Transfers in the last two weeks before the session are only allowed if an annual state survey is in progress at your facility. Substitutions (sending a different person to the session) are always accepted at no charge.